Welsh health minister Edwina Hart has axed the internal market and put herself centre stage in a wholesale reform of the country's NHS.
The eight acute trusts and 22 local health boards will be replaced with seven unified organisations merging primary and secondary care.
Planning and funding will be overseen by a national advisory board chaired by the minister. The new body, to be composed of specialists appointed by the assembly government, will meet in public. This could mean open political rows over issues such as access to drugs and reconfigurations.
The minister defended her approach after the announcement to the Welsh Assembly on Tuesday.
It was "impracticable and undesirable" to create distance between political responsibility and service delivery, she said. "I was not prepared to stand here and say, 'That's a matter for somebody else.'"
Conservative shadow health minister Jonathan Morgan told Ms Hart she was "politicising the NHS in a way I never thought possible".
Chairs of the regional organisations will be appointed by the minister, as well as vice chairs with special responsibility for primary, community and mental health care.
Chief executives and chairs will report to the advisory board. Ms Hart said the board would be in place by April, while the local bodies may take over later in the year.
Welsh NHS Confederation director Mike Ponton said: "This is a positive step that will simplify the system."
See Care vs security in mental health services for more